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A comparison of autologous cell salvage versus allogenic blood transfusion in patients undergoing pelvic and acetabular trauma surgery
Abstracts / Injury Extra 40 (2009) 183–235
Perhaps their most major contribution is that in the field of education where they became and remain the single largest educational group in the field of orthopaedic traumatology. Their synergistic relationship with a single major producer may also prove to be of use to all practising trauma surgeons as a model for the relationships that necessary will need to exist between surgeon and implant manufacturer. The contribution of the AO to classification of fractures is also a major contribution to patient care. Keywords: Evidence based medicine; Education; Research and classification doi:10.1016/j.injury.2009.06.255 7A.1
7A: Pelvis–Acetabulum–Lower Limb A national survey on the management of thrombo-prophylaxis in pelvic and acetabular trauma patients E. Guryel ∗ , R. Pearce, M. Rickman, M. Bircher St George’s Hospital, UK The severely injured patient with pelvic and acetabular injuries present a number of difficulties for the trauma surgeon including significantly higher rates of thrombo-embolic complications. For these patients the literature indicates that the incidence of deep vein thrombosis (DVT) varies between 35% and 61% and proximal DVT between 25% and 35%. The risk of symptomatic pulmonary embolism (PE) is up to 10% with the risk of fatal PE as high as 2%. Questionnaires were sent to the major pelvic and acetabular trauma centres in the UK in order to ascertain their thromboprophylactic management in three main groups of patients. Firstly, those admitted for surgery, secondly, those admitted but ultimately not requiring surgery and, thirdly, those for which telephone advice was given but the patient did not require transfer or surgery. Replies were received from 16 centres, which between them perform more than 700 pelvic and acetabular operations per year. We present the findings from this survey and also compare them with centres in Canada and North America. Keywords: Thrombo-prophylaxis; Pelvic; Acetabular; Survey doi:10.1016/j.injury.2009.06.256 7A.2 A comparison of autologous cell salvage versus allogenic blood transfusion in patients undergoing pelvic and acetabular trauma surgery S. Chaudhry ∗ , M. Coombe, J. Cooper University Hospital Birmingham, UK Introduction: Cell salvage is a blood conservation modality often used as a blood saving technology in many aspects of elective orthopaedics but its use in trauma has not gained widespread recognition. There have been no previous reports of cell salvage usage in open surgery for pelvic and acetabular trauma. Methods: We undertook a retrospective cohort study. All patients between 2004 and 2008 who underwent open pelvic or acetabular surgery were divided them into group A—those who had intraoperative cell salvage and group B—those who had allogenic blood crossmatched and transfused intra/post-operatively as required. We used case notes alongside the theatre hospital computer database to document patient demographics, operative
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approach, haemoglobin levels, blood crossmatched, actual amounts transfused for each patient and also compared the costs. Results: 32 patients had surgery with the use of a cell saver (A) versus 30 who did not (B). The patients in both groups were similar in their demographics, blood results and the surgical approaches used. In group A, the average volume re-transfused was 433 ml per patient. The average amount saved per patient was £113 with a total saving of £5884. In group B, 80% of patients required a mean of 4 units of blood at a total cost of £16,050. We calculated an 89% reduction in need for transfusion with cell salvage. Conclusion: Our results demonstrate that cell salvage is a cost effective technique in pelvic/and acetabular trauma patients with no adverse events. There is a reduced need for blood transfusions postoperatively as well as a reduced risk for transfusion reactions and transmission of blood borne infections. We demonstrate that by conserving blood for other uses this technique is useful to the hospital as a whole. Keywords: Acetabular fracture; Pelvic; Cell saver; Blood transfusion doi:10.1016/j.injury.2009.06.257 7A.3 Lateral compression type I injuries of the pelvic ring: Are they mechanically stable? N.K. Kanakaris ∗ , C. Tzioupis, V.S. Nikolaou, P.V. Giannoudis Leeds General Infirmary, UK Aim: To investigate whether lateral compression type I injuries of the pelvic ring are inheritably mechanically stable. Patients and methods: Between January 2005 and January 2007 all consecutive admissions of a tertiary referral centre for pelvic ring reconstruction with a LC I injury pattern were eligible for inclusion. Exclusion criteria were other patterns of pelvic ring injuries. All patients underwent radiological assessment including AP pelvis, inlet/outlet views and CT. Patient demographics, mechanism of injury, other associated injuries, ISS, length of hospitalisation, type of operation, mode of mobilisation, preoperative and postoperative visual analogue score pain VAS and follow up until fracture union were prospectively documented. Mechanical stability of the pelvic ring was assessed in the operating theatre under general anaesthesia. Instability was defined as displacement >2 cm of the anterior or posterior elements. The minimum follow up was 12 months. Results: Out of 210 patients admitted with pelvic fractures, 40 fulfilled the inclusion criteria (LC1 type). There were 23 female 17 male and with a mean age of 33.5 (range 18–68). The mean ISS was 10 (range 9–19). 23 patients (group 1) were found to have more than 2 cm rotational displacement during EUA and were stabilised with SI screws posteriorly and a combination of retropubic screws, external fixator or plating anteriorly. 17 patients (group 2) exhibited minimal displacement less than 5 mm and were not stabilised. Rotational instability >2 cm was characterised by complete fracture of the sacrum posteriorly. Stabilisation of the pelvic ring in group I was associated with a significant reduction of the VAS within 72 h from surgery, early ambulation and discharge from the hospital. Conclusion: This study supports the view that not all LCI fracture patterns are mechanically stable. Examination under anaesthesia of the pelvic ring can assist the clinician in the decision making progress. Keywords: Lateral compression; Pelvic fractures; Clinical; Case/control series doi:10.1016/j.injury.2009.06.258
Perhaps their most major contribution is that in the field of education where they became and remain the single largest educational group in the field of orthopaedic traumatology. Their synergistic relationship with a single major producer may also prove to be of use to all practising trauma surgeons as a model for the relationships that necessary will need to exist between surgeon and implant manufacturer. The contribution of the AO to classification of fractures is also a major contribution to patient care. Keywords: Evidence based medicine; Education; Research and classification doi:10.1016/j.injury.2009.06.255 7A.1
7A: Pelvis–Acetabulum–Lower Limb A national survey on the management of thrombo-prophylaxis in pelvic and acetabular trauma patients E. Guryel ∗ , R. Pearce, M. Rickman, M. Bircher St George’s Hospital, UK The severely injured patient with pelvic and acetabular injuries present a number of difficulties for the trauma surgeon including significantly higher rates of thrombo-embolic complications. For these patients the literature indicates that the incidence of deep vein thrombosis (DVT) varies between 35% and 61% and proximal DVT between 25% and 35%. The risk of symptomatic pulmonary embolism (PE) is up to 10% with the risk of fatal PE as high as 2%. Questionnaires were sent to the major pelvic and acetabular trauma centres in the UK in order to ascertain their thromboprophylactic management in three main groups of patients. Firstly, those admitted for surgery, secondly, those admitted but ultimately not requiring surgery and, thirdly, those for which telephone advice was given but the patient did not require transfer or surgery. Replies were received from 16 centres, which between them perform more than 700 pelvic and acetabular operations per year. We present the findings from this survey and also compare them with centres in Canada and North America. Keywords: Thrombo-prophylaxis; Pelvic; Acetabular; Survey doi:10.1016/j.injury.2009.06.256 7A.2 A comparison of autologous cell salvage versus allogenic blood transfusion in patients undergoing pelvic and acetabular trauma surgery S. Chaudhry ∗ , M. Coombe, J. Cooper University Hospital Birmingham, UK Introduction: Cell salvage is a blood conservation modality often used as a blood saving technology in many aspects of elective orthopaedics but its use in trauma has not gained widespread recognition. There have been no previous reports of cell salvage usage in open surgery for pelvic and acetabular trauma. Methods: We undertook a retrospective cohort study. All patients between 2004 and 2008 who underwent open pelvic or acetabular surgery were divided them into group A—those who had intraoperative cell salvage and group B—those who had allogenic blood crossmatched and transfused intra/post-operatively as required. We used case notes alongside the theatre hospital computer database to document patient demographics, operative
217
approach, haemoglobin levels, blood crossmatched, actual amounts transfused for each patient and also compared the costs. Results: 32 patients had surgery with the use of a cell saver (A) versus 30 who did not (B). The patients in both groups were similar in their demographics, blood results and the surgical approaches used. In group A, the average volume re-transfused was 433 ml per patient. The average amount saved per patient was £113 with a total saving of £5884. In group B, 80% of patients required a mean of 4 units of blood at a total cost of £16,050. We calculated an 89% reduction in need for transfusion with cell salvage. Conclusion: Our results demonstrate that cell salvage is a cost effective technique in pelvic/and acetabular trauma patients with no adverse events. There is a reduced need for blood transfusions postoperatively as well as a reduced risk for transfusion reactions and transmission of blood borne infections. We demonstrate that by conserving blood for other uses this technique is useful to the hospital as a whole. Keywords: Acetabular fracture; Pelvic; Cell saver; Blood transfusion doi:10.1016/j.injury.2009.06.257 7A.3 Lateral compression type I injuries of the pelvic ring: Are they mechanically stable? N.K. Kanakaris ∗ , C. Tzioupis, V.S. Nikolaou, P.V. Giannoudis Leeds General Infirmary, UK Aim: To investigate whether lateral compression type I injuries of the pelvic ring are inheritably mechanically stable. Patients and methods: Between January 2005 and January 2007 all consecutive admissions of a tertiary referral centre for pelvic ring reconstruction with a LC I injury pattern were eligible for inclusion. Exclusion criteria were other patterns of pelvic ring injuries. All patients underwent radiological assessment including AP pelvis, inlet/outlet views and CT. Patient demographics, mechanism of injury, other associated injuries, ISS, length of hospitalisation, type of operation, mode of mobilisation, preoperative and postoperative visual analogue score pain VAS and follow up until fracture union were prospectively documented. Mechanical stability of the pelvic ring was assessed in the operating theatre under general anaesthesia. Instability was defined as displacement >2 cm of the anterior or posterior elements. The minimum follow up was 12 months. Results: Out of 210 patients admitted with pelvic fractures, 40 fulfilled the inclusion criteria (LC1 type). There were 23 female 17 male and with a mean age of 33.5 (range 18–68). The mean ISS was 10 (range 9–19). 23 patients (group 1) were found to have more than 2 cm rotational displacement during EUA and were stabilised with SI screws posteriorly and a combination of retropubic screws, external fixator or plating anteriorly. 17 patients (group 2) exhibited minimal displacement less than 5 mm and were not stabilised. Rotational instability >2 cm was characterised by complete fracture of the sacrum posteriorly. Stabilisation of the pelvic ring in group I was associated with a significant reduction of the VAS within 72 h from surgery, early ambulation and discharge from the hospital. Conclusion: This study supports the view that not all LCI fracture patterns are mechanically stable. Examination under anaesthesia of the pelvic ring can assist the clinician in the decision making progress. Keywords: Lateral compression; Pelvic fractures; Clinical; Case/control series doi:10.1016/j.injury.2009.06.258